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Zhu J, Yan Y, Jiang W, Zhang S, Niu X, Wan S, Cong Y, Hu X, Zheng B, Yang Y. A Deep Learning Model for Automatically Quantifying the Anterior Segment in Ultrasound Biomicroscopy Images of Implantable Collamer Lens Candidates. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1262-1272. [PMID: 38777640 DOI: 10.1016/j.ultrasmedbio.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This study aimed to develop and evaluate a deep learning-based model that could automatically measure anterior segment (AS) parameters on preoperative ultrasound biomicroscopy (UBM) images of implantable Collamer lens (ICL) surgery candidates. METHODS A total of 1164 panoramic UBM images were preoperatively obtained from 321 patients who received ICL surgery in the Eye Center of Renmin Hospital of Wuhan University (Wuhan, China) to develop an imaging database. First, the UNet++ network was utilized to segment AS tissues automatically, such as corneal lens and iris. In addition, image processing techniques and geometric localization algorithms were developed to automatically identify the anatomical landmarks (ALs) of pupil diameter (PD), anterior chamber depth (ACD), angle-to-angle distance (ATA), and sulcus-to-sulcus distance (STS). Based on the results of the latter two processes, PD, ACD, ATA, and STS can be measured. Meanwhile, an external dataset of 294 images from Huangshi Aier Eye Hospital was employed to further assess the model's performance in other center. Lastly, a subset of 100 random images from the external test set was chosen to compare the performance of the model with senior experts. RESULTS Whether in the internal test dataset or external test dataset, using manual labeling as the reference standard, the models achieved a mean Dice coefficient exceeding 0.880. Additionally, the intra-class correlation coefficients (ICCs) of ALs' coordinates were all greater than 0.947, and the percentage of Euclidean distance distribution of ALs within 250 μm was over 95.24%.While the ICCs for PD, ACD, ATA, and STS were greater than 0.957, furthermore, the average relative error (ARE) of PD, ACD, ATA, and STS were below 2.41%. In terms of human versus machine performance, the ICCs between the measurements performed by the model and those by senior experts were all greater than 0.931. CONCLUSION A deep learning-based model could measure AS parameters using UBM images of ICL candidates, and exhibited a performance similar to that of a senior ophthalmologist.
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Affiliation(s)
- Jian Zhu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yulin Yan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Weiyan Jiang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Shaowei Zhang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiaoguang Niu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Shanshan Wan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yuyu Cong
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiao Hu
- Wuhan EndoAngel Medical Technology Company, Wuhan, China
| | - Biqin Zheng
- Wuhan EndoAngel Medical Technology Company, Wuhan, China
| | - Yanning Yang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
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Wang H, Zhang B, Du W, Sun Z, Fan Q, Pang C. The optimization of the vault-predicting formula based on the anterior segment measurements from artemis insight 100. Sci Rep 2024; 14:13296. [PMID: 38858519 PMCID: PMC11164931 DOI: 10.1038/s41598-024-64390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/07/2024] [Indexed: 06/12/2024] Open
Abstract
To optimize and evaluate the accuracy of the vault-predicting formula generated from a very high-frequency digital ultrasound robotic scanner (Artemis Insight 100). The relationship between the achieved lens vault (LVa) at one month after intraocular collamer lens (ICL) implantation surgery and the predicted vault (LVp) was analyzed by a retrospective study, and an optimized formula was built up. Then, the accuracy of the optimized vault-predicting formula was evaluated in a prospective study by comparing the LVa and the predicted vault from the optimized formula (LVop). The retrospective study included 77 patients (133 eyes) while the prospective study enrolled 90 patients (170 eyes). The difference between LVp and LVa at one month after surgery was statistically significant (P < 0.05), and the linear regression analysis of LVa against LVp yielded a good fit (R2 = 0.68). The optimized vault-predicting formula was LVop (μm) = 1.21 × LVp (μm) + 124.73. In the validation study, the difference between LVop and LVa was not statistically significant (P = 0.10), and a good agreement between LVop and LVa was shown by Bland-Altman analysis. The optimized vault-predicting formula could predict the actual LV after ICL implantation surgery, help to select an appropriate ICL size and reduce the need for re-operation.
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Affiliation(s)
- Hao Wang
- Department of Refractive Surgery, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, Henan Eye Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, People's Hospital Affiliated to Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, People's Hospital Affiliated to Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Bo Zhang
- Department of Refractive Surgery, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, Henan Eye Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, People's Hospital Affiliated to Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, People's Hospital Affiliated to Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Wenwen Du
- Department of Refractive Surgery, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, Henan Eye Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, People's Hospital Affiliated to Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, People's Hospital Affiliated to Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Zaohe Sun
- Department of Refractive Surgery, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, Henan Eye Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, People's Hospital Affiliated to Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, People's Hospital Affiliated to Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Qi Fan
- Department of Refractive Surgery, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, Henan Eye Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, People's Hospital Affiliated to Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, China
- Department of Refractive Surgery, People's Hospital Affiliated to Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China
| | - Chenjiu Pang
- Department of Refractive Surgery, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China.
- Department of Refractive Surgery, Henan Eye Hospital, No. 7 Weiwu Road, Zhengzhou, 450003, China.
- Department of Refractive Surgery, People's Hospital Affiliated to Zhengzhou University, No. 7 Weiwu Road, Zhengzhou, 450003, China.
- Department of Refractive Surgery, People's Hospital Affiliated to Henan University, No. 7 Weiwu Road, Zhengzhou, 450003, China.
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Jiang Y, Chen X, Cheng M, Li B, Lei Y, Lin IC, Xu G, Mingwei L, Zhou X, Wang X. Immediate versus delayed sequential bilateral ICL implantation: A retrospective comparison of vault height and visual outcomes. Asia Pac J Ophthalmol (Phila) 2024:100075. [PMID: 38795866 DOI: 10.1016/j.apjo.2024.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/28/2024] Open
Abstract
PURPOSE To compare the visual outcomes and risks of suboptimal vault-related complications between immediate sequential bilateral ICL surgery (ISBICLS) and delayed sequential bilateral ICL surgery (DSBICLS). DESIGN A retrospective cohort study. METHODS Patients who underwent bilateral ICL implantation between November 2014 and December 2021 at the Eye and ENT Hospital of Fudan University (Shanghai, China) were included and divided into two groups: (1) ISBICLS: both eye surgeries performed on the same day, and (2) DSBICLS: second eye surgery performed < 7 days following the first one. Propensity score matching (PSM) was performed to compare the visual outcomes. Multivariable logistic regression models were used to estimate the odds ratios (ORs) of the suboptimal vaults. RESULTS Finally, 10,985 eyes were included. After PSM, 204 first surgery eyes and 162 s surgery eyes with complete postoperative data were matched. The safety and efficacy indices did not statistically differ between groups (all > 1.00), except that ISBICLS first surgery eyes achieved better efficacy index than DSBICLS group (1.03 ± 0.26 vs. 1.08 ± 0.23, P = 0.034). Excessive vault was observed in eight (4.06 %) ISBICLS first eyes, one (0.50 %) DSBICLS first eye, and none in the second surgery eye in either group. An insufficient vault was observed in one second eye and one DSBICLS second eye. We found no evidence of differences in the rate of excessive vault (OR = 0.831, 95 % CI: 0.426-1.622, P = 0.588) or insufficient vault (OR = 0.609, 95 % CI:0.062-5.850, P = 0.668). CONCLUSION ISBICLS provided safety, efficacy, and refraction predictability comparable to DSBICLS without increasing the risk of suboptimal vault-related complications.
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Affiliation(s)
- Yinjie Jiang
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Xun Chen
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Mingrui Cheng
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Boliang Li
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Yadi Lei
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - I-Chun Lin
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Guanghan Xu
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Li Mingwei
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Xingtao Zhou
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Xiaoying Wang
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences.
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Zou Q, Zhao S, Cheng L, Song C, Yuan P, Zhu R. Effects of crystalline lens rise and anterior chamber parameters on vault after implantable collamer lens placement. PLoS One 2024; 19:e0296811. [PMID: 38512912 PMCID: PMC10956874 DOI: 10.1371/journal.pone.0296811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/19/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND To analyze vault effects of crystalline lens rise (CLR) and anterior chamber parameters (recorded by Pentacam) in highly myopic patients receiving implantable collamer lenses (ICLs), which may avoid subsequent complications such as glaucoma and cataract caused by the abnormal vault. METHODS We collected clinical data of 137 patients with highly myopic vision, who were all subsequent recipients of V4c ICLs between June 2020 and January 2021. Horizontal ciliary sulcus-to-sulcus diameter (hSTS) and CLR were measured by ultrasonic biomicroscopy (UBM), and a Pentacam anterior segment analyzer was used to measure horizontal white-to-white diameter (hWTW), anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), CLR, and postoperative vault (Year 1 and Month 1). The lens thickness (LT) was determined by optical biometry (IOL Master instrument). The predictive model was generated through multiple linear regression analyses of influential factors, such as hSTS, CLR, hWTW, ACD, ACA, ACV, ICL size, and LT. The predictive performance of the multivariate model on vault after ICL was assessed using the receiver operating characteristic (ROC) curve with area under the curve (AUC) as well as the point of tangency. RESULTS Average CLR assessed by UBM was lower than the average value obtained by Pentacam (0.561 vs. 0.683). Bland-Altman analysis showed a good consistency in the two measurement methods and substantial correlation (r = 0.316; P = 0.000). The ROC curve of Model 1 (postoperative Year 1) displayed an AUC of 0.847 (95% confidence interval [CI]: 74.19-95.27), with optimal threshold of 0.581 (sensitivity, 0.857; specificity, 0.724). In addition, respective values for Model 2 (postoperative Month 1) were 0.783 (95% CI: 64.94-91.64) and 0.522 (sensitivity, 0.917; specificity, 0.605). CONCLUSION CLR and anterior chamber parameters are important determinants of postoperative vault after ICL placement. The multivariate regression model we constructed may serve in large part as a predictive gauge, effectively avoid postoperative complication.
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Affiliation(s)
- Quan Zou
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
| | - Sen Zhao
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
| | - Lei Cheng
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
| | - Chao Song
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
| | - Ping Yuan
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
| | - Ran Zhu
- Department of Center of Refraction, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medicine University, Xuzhou, Jiangsu Province, P. R. China
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Di Y, Fang H, Luo Y, Li Y, Xu Y. Predicting Implantable Collamer Lens Vault Using Machine Learning Based on Various Preoperative Biometric Factors. Transl Vis Sci Technol 2024; 13:8. [PMID: 38224328 PMCID: PMC10793387 DOI: 10.1167/tvst.13.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/06/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose To predict the vault size after Implantable Collamer Lens (ICL) V4c implantation using machine learning methods and to compare the predicted vault with the conventional manufacturer's nomogram. Methods This study included 707 patients (707 eyes) who underwent ICL V4c implantation at the Department of Ophthalmology, Peking Union Medical College Hospital, from September 2019 to January 2022. Random Forest Regression (RFR), XGBoost, and linear regression (LR) were used to predict the vault size 1 week after ICL V4c implantation. The mean absolute error (MAE), median absolute error (MedAE), root mean square error (RMSE), symmetric mean absolute percentage error (SMAPE), and Bland-Altman plot were utilized to compare the prediction performance of these machine learning methods. Results The dataset was divided into a training set of 180 patients (180 eyes) and a test set of 527 patients (527 eyes). XGBoost had the lowest prediction error, with mean MAE, RMSE, and SMAPE values of 121.70 µm, 148.87 µm, and 19.13%, respectively. The Bland‒Altman plots of RFR and XGBoost showed better prediction consistency than LR. However, XGBoost showed narrower 95% limits of agreement (LoA) than RFR, ranging from -307.12 to 256.59 µm. Conclusions XGBoost demonstrated better predictive performance than RFR and LR, as it had the lowest prediction error and the narrowest 95% LoA. Machine learning may be applicable for vault prediction, and it might be helpful for reducing the complications and the secondary surgery rate. Translational Relevance Using the proposed machine learning model, surgeons can consider the postoperative vault to reduce the surgical complications.
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Affiliation(s)
- Yu Di
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huihui Fang
- School of Future Technology, South China University of Technology, Guangzhou, China
- Pazhou Lab, Guangzhou, China
| | - Yan Luo
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanwu Xu
- School of Future Technology, South China University of Technology, Guangzhou, China
- Pazhou Lab, Guangzhou, China
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Wu H, Luo DQ, Chen J, Wang H, Zhong DJ. Comparison of the Accuracy of Seven Vault Prediction Formulae for Implantable Collamer Lens Implantation. Ophthalmol Ther 2024; 13:237-249. [PMID: 37943482 PMCID: PMC10776513 DOI: 10.1007/s40123-023-00844-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION This study aimed to compare the accuracy of seven implantable collamer lens (ICL) implantation vault prediction formulae. METHODS We retrospectively analyzed 328 patients (328 eyes) who underwent ICL implantation and the prediction accuracy of seven formulae: NK, KS, WH, Luo, Zhu, Hun, and ZZ were compared. Moreover, the accuracy of the seven formulae for different ICL sizes was compared. The formulae were tested using mean absolute prediction error (MAE), median absolute prediction error (MedAE), prediction error (PE) percentages at ± 50 µm, ± 100 µm, ± 200 µm, and ± 300 µm, and Bland-Altman analysis. RESULTS The PE of the seven formulae were statistically significant (P < 0.001). The KS (101.00 µm) and WH formulae (116.65 µm) had the smallest MedAE, followed by the Luo (123.62 µm), NK (141.50 µm), Hun (152.68 µm), ZZ (196.00 µm) and Zhu formula (225.98 µm). The highest percentage of PE in the range of ± 300µm was 94.3% and 93% for the KS and WH formulae, respectively. Among the different ICL size groupings, the KS formula predicted the smallest MedAE for 12.1 mm and 12.6 mm, whereas the Luo and WH formulae predicted the smallest MedAE for 13.2 mm and 13.7 mm, respectively. CONCLUSIONS The KS and WH formulae provided better outcomes by predicting the vault with higher accuracy than of the NK, Hun, Luo, ZZ, and Zhu formulae. TRIAL REGISTRATION ChiCTR2200065501.
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Affiliation(s)
- Hao Wu
- Department of Optometry and Ophthalmology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No. 61 West Jiefang Road, Changsha, China
| | - Dong-Qiang Luo
- Department of Optometry and Ophthalmology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No. 61 West Jiefang Road, Changsha, China
| | - Jiao Chen
- Department of Optometry and Ophthalmology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No. 61 West Jiefang Road, Changsha, China
| | - Hua Wang
- Department of Optometry and Ophthalmology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No. 61 West Jiefang Road, Changsha, China.
| | - Ding-Juan Zhong
- Department of Optometry and Ophthalmology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No. 61 West Jiefang Road, Changsha, China.
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Yiming Y, Xi C, Huan Y, Liming C, Na Y, Pei C, Ying Y, Yan L, Keming Y. Evaluation of ciliary body morphology and position of the implantable collamer lens in low-vault eyes using ultrasound biomicroscopy. J Cataract Refract Surg 2023; 49:1133-1139. [PMID: 37586102 DOI: 10.1097/j.jcrs.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE To investigate the ciliary body anatomy and position of the implantable collamer lens (ICL) in low-vault eyes and analyze factors related to insufficient vault. SETTING Zhongshan Ophthalmic Center, Guangzhou, China. DESIGN Retrospective case-control observational study. METHODS In this study, 73 eyes of 73 patients with an insufficient vault (<250 μm) were matched with 73 eyes with an ideal vault (250 to 750 μm). Ultrasound biomicroscopy was used to determine the ciliary body morphology and ICL position. The biometric parameters acquired by Scheimpflug tomography were compared. The correlation between the vault and these factors was analyzed, and the least absolute shrinkage and selection operator method was used to screen the risk factors for low vault. RESULTS The low-vault group had a steeper corneal curvature, thicker lens thickness (LT), higher crystalline lens rise, and shorter axial length (AL) (all P < .005). The ciliary process length (CPL) and maximum ciliary body thickness (CBTmax) were significantly smaller, and the trabecular-ciliary angle (TCA), iris-ciliary angle (ICA), and ciliary sulcus width (CSW) were significantly greater in the low-vault eyes (all P < .005). The low-vault group had more ICL haptics below the ciliary process, and TCA, ICA, CPL, CBTmax, CSW, and haptic position were related to the postoperative vault (all P < .05). CPL, AL, and LT were identified as predictors of a low vault. CONCLUSIONS Malposition of ICL haptics behind the ciliary process is a risk factor for low vault. A shorter CPL, thicker LT, and shorter AL are significant risk factors for the postoperative low vault.
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Affiliation(s)
- Ye Yiming
- From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Cui W, Wu X, Ren Q, Liu K, Kong F, Wu J. A new formula based on new parameters for predicting postoperative vault after posterior chamber intraocular lens implantation: a retrospective study. Quant Imaging Med Surg 2023; 13:5502-5510. [PMID: 37711770 PMCID: PMC10498263 DOI: 10.21037/qims-22-1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 07/10/2023] [Indexed: 09/16/2023]
Abstract
Background To investigate the parameters influencing vault after posterior chamber intraocular lens implantation, thereby establishing a formula to predict the vault after operation. Methods In this retrospective study, 61 patients (122 eyes) who underwent implantable collamer lens (ICL) implantation were enrolled consecutively from the Qingdao Eye Hospital of Shandong First Medical University, China, between August 2020 and October 2021. Comprehensive optometry, axial length, curvature, anterior chamber depth (ACD), lens thickness (LT), white-to-white distance (WTW), corneal thickness, sulcus-to-sulcus distance (STS), the distance between the sulcus-to-sulcus plane and the anterior crystalline lens surface (STSL), ciliary-to-ciliary distance (CTC) and the distance between the ciliary-to-ciliary plane and the anterior crystalline lens surface (CTCL) were recorded preoperatively. The vault was measured by ultrasound biomicroscopy at 1 month after operation. The correlation among vault, preoperative parameters and ICL size was analyzed. The accuracy and reliability of the prediction formula were verified by analyzing the postoperative correlation coefficient of actual and predicted vaults of the contralateral eye and through the Bland-Altman consistency test. Results Parameters significantly influencing the vault at 1 month after operation are ACD (r=0.260, P=0.004), LT (r=-0.338, P<0.001), WTW (r=0.240, P=0.03), STSL (r=-0.394, P<0.001), CTC (r=-0.199, P=0.03), CTCL (r=-0.328, P<0.001), ICL size (r=0.224, P=0.01) and ICL power (r=-0.231, P=0.01). The regression formula was as follows: vault (mm) = -2.179 - 0.227 * CTC (vertical) - 0.783 * CTCL (mean) + 0.472 * ICL size (fitting R=0.853, R2=0.727, adjusted R2=0.705). The predicted vault was 0.50±0.18 mm, and the actual vault was 0.56±0.24 mm. The Bland-Altman scatter plot showed a satisfactory agreement between actual and predicted vaults (-0.06 mm, 95% limits of agreement: -0.45 to 0.32 mm). Conclusions ACD, LT, WTW, STSL, CTC, CTCL, ICL size and ICL power were the factors affecting vault after ICL implantation. The prediction formula with the new parameter CTCL was accurate and reliable.
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Affiliation(s)
- Wei Cui
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Xiaoming Wu
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Qi Ren
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Kun Liu
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Fanqin Kong
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
| | - Jie Wu
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Qingdao, China
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9
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Beltrán-Murcia J, Capelo LÁR, Blázquez-Sánchez V. Analysis of vault prediction in phakic implantable phakic collamer lenses: manufacturer's calculator vs theoretical formulae vs clinical practice. Graefes Arch Clin Exp Ophthalmol 2023; 261:2403-2409. [PMID: 36914818 DOI: 10.1007/s00417-023-06016-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/06/2022] [Accepted: 02/22/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Implantable collamer phakic (ICL) intraocular lens sizing calculations are necessary to avoid complications associated to inadequate sizing. Historically, Holladay R, Dougherty, Hernández-Matamoros, and other authors have tried to create new formulas that solve calculation problems and provide higher reliability. In addition, in recent years, the appearance of new equipment, parameters, and formulas have led to significant progress. This paper compares the sizing according to manufacturer's method and other methods. METHODS Forty-three eyes of 24 patients with EVO ICL implanted, with at least 1 year of follow-up, were analysed. The analysed variables were white to white (WTW), anterior chamber depth (ACD), ACW (angle-to-angle), crystalline lens rise (CLR), ICL size, vault measured at 1 week and 1 year after surgery, ICL size, and vault predicted by Nakamura-2 as well as vault size predicted by Igarashi. RESULTS Sizing calculation with Online Calculation and Ordering System according to WTW and ACD is a good indicator with 86% success rate. The calculation with Nakamura 2 suggests larger ICL sizes in 32.5% of cases and smaller in 18.6% of cases, while the resulting Vault according to Igarashi obtains better results without significant differences. CONCLUSIONS ICL sizing according WTW and ACD, using the manufacturer's algorithm, seems to be the most predictable method compared to other algorithms using other variables. The surgeon's expertise also has a high importance in the final ICL size election.
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Affiliation(s)
| | | | - Vanesa Blázquez-Sánchez
- Faculty of Optics and Optometry, Complutense University, Madrid, Spain.
- Clínica Rementería, 36 Almagro Street, 28010, Madrid, Spain.
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10
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Tan X, Liu W, Chang Y, Wu W, Yang L, Liu J. Analysis of Inter-Eye Vault Differences After Implantable Collamer Lens (V4c) Implantation. Int J Gen Med 2023; 16:2451-2459. [PMID: 37346811 PMCID: PMC10281286 DOI: 10.2147/ijgm.s384858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023] Open
Abstract
Purpose The safety and stability of implantable collamer lens (ICL) implantation are closely related to the vault. We aimed to assess clinical data from patients with similar anterior segment anatomy who received ICL of the same model placed in the same position and analyze common range and factors affecting the vault inter-eye difference. Patients and Methods A prospective study was performed, including 162 eyes of 81 patients with a bilateral ICL (V4c) implantation. Subjects were evaluated before the surgery and 1 day, 1 week, and 1 month postoperatively, and they were divided into 4 groups based on the ICL size. Bivariate correlation and multiple linear regression (stepwise) analyzed associations between vault inter-eye differences and horizontal sulcus-to-sulcus diameter, anterior chamber depth, lens thickness, ICL size, spherical equivalent, and vault. Results One month after surgery, mean vault inter-eye differences were 74.59 ± 55.59 µm. Nearly 70% of patients presented with vault inter-eye differences lower than 100 µm. The second eye vault variance of 69% was attributed to the first eye vault. Vault inter-eye differences were positively correlated with ICL spherical equivalent (regression equation: vault inter-eye differences (μm) = 139.415 + 6.295 × ICL spherical equivalent). Vaults after ICL implantation were similar in fellow eyes, with some considerable differences. The 95% confidence interval of the vault inter-eye difference was -34.4 ~ 183.6 μm. Conclusion In eyes with similar anterior segment anatomy, there is a 95% probability that the vault will vary from -34.4 μm to -183.6 μm when a similar ICL is implanted. These results can help surgeons to select an appropriate ICL size to achieve an ideal vault. The smaller the spherical equivalent, the larger the difference between the two vaults, which provides a reference for size in moderate myopia. ICL spherical equivalent affects and predicts vault inter-eye differences after ICL implantation.
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Affiliation(s)
- Xin Tan
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
| | - Wenjie Liu
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
| | - Ying Chang
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
| | - Wanmin Wu
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
| | - Lichun Yang
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
| | - Jiewei Liu
- Cataract Department, Shanxi Eye Hospital, Taiyuan, Shanxi Province, People’s Republic of China
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11
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Chen X, Ye Y, Yao H, Liu C, He A, Hou X, Zhao K, Cui Z, Li Y, Qiu J, Chen P, Yang Y, Zhuang J, Yu K. Predicting post-operative vault and optimal implantable collamer lens size using machine learning based on various ophthalmic device combinations. Biomed Eng Online 2023; 22:59. [PMID: 37322471 DOI: 10.1186/s12938-023-01123-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Implantable Collamer Lens (ICL) surgery has been proven to be a safe, effective, and predictable method for correcting myopia and myopic astigmatism. However, predicting the vault and ideal ICL size remains technically challenging. Despite the growing use of artificial intelligence (AI) in ophthalmology, no AI studies have provided available choices of different instruments and combinations for further vault and size predictions. This study aimed to fill this gap and predict post-operative vault and appropriate ICL size utilizing the comparison of numerous AI algorithms, stacking ensemble learning, and data from various ophthalmic devices and combinations. RESULTS This retrospective and cross-sectional study included 1941 eyes of 1941 patients from Zhongshan Ophthalmic Center. For both vault prediction and ICL size selection, the combination containing Pentacam, Sirius, and UBM demonstrated the best results in test sets [R2 = 0.499 (95% CI 0.470-0.528), mean absolute error = 130.655 (95% CI 128.949-132.111), accuracy = 0.895 (95% CI 0.883-0.907), AUC = 0.928 (95% CI 0.916-0.941)]. Sulcus-to-sulcus (STS), a parameter from UBM, ranked among the top five significant contributors to both post-operative vault and optimal ICL size prediction, consistently outperforming white-to-white (WTW). Moreover, dual-device combinations or single-device parameters could also effectively predict vault and ideal ICL size, and excellent ICL selection prediction was achievable using only UBM parameters. CONCLUSIONS Strategies based on multiple machine learning algorithms for different ophthalmic devices and combinations are applicable for vault predicting and ICL sizing, potentially improving the safety of the ICL implantation. Moreover, our findings emphasize the crucial role of UBM in the perioperative period of ICL surgery, as it provides key STS measurements that outperformed WTW measurements in predicting post-operative vault and optimal ICL size, highlighting its potential to enhance ICL implantation safety and accuracy.
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Affiliation(s)
- Xi Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yiming Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Huan Yao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Chang Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Anqi He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiangtao Hou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Keming Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zedu Cui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jin Qiu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Pei Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ying Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Keming Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, Guangzhou, People's Republic of China.
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12
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Di Y, Li Y, Luo Y. Prediction of Implantable Collamer Lens Vault Based on Preoperative Biometric Factors and Lens Parameters. J Refract Surg 2023; 39:332-339. [PMID: 37162400 DOI: 10.3928/1081597x-20230207-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To establish and validate the accuracy of implantable collamer lens (ICL) vault size prediction formula based on preoperative biometric factors and lens parameters. METHODS This study included 300 patients (300 eyes) with Visian ICL V4c (STAAR Surgical) implantation. They were randomly divided into the formula establishment group and formula validation group. Anterior segment measurements, ICL V4c size and power, and vault 1 week postoperatively were collected from all patients. Multiple linear regression analysis was performed to establish the prediction formula. Mean absolute error (MAE), median absolute error (MedAE), root mean square error (RMSE), and Bland-Altman diagrams were used to evaluate the prediction formula. RESULTS Anterior chamber depth (ACD) had the greatest influence on vault 1 week after ICL V4c implantation, followed by ICL V4c size and angle-to-angle distance (ATA). The prediction formula was obtained according to the partial regression coefficient, which was vault (mm) = -1.279 + 0.291 × ACD (mm) + 0.210 × ICL V4c size (mm) - 0.144 × ATA (mm) (R2 = 0.661). In the formula validation group, the mean predictive vault, MAE, MedAE, and RMSE were 628.10, 135.09, 130.42, and 150.46 µm, respectively. The Bland-Altman diagram showed the predictive vault was in good agreement with the actual vault. CONCLUSIONS A novel ICL V4c vault prediction formula was developed and shown to be an effective method for predicting the vault to reduce surgical complications. [J Refract Surg. 2023;39(5):332-339.].
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Martínez-Plaza E, López-de la Rosa A, López-Miguel A, Holgueras A, Maldonado MJ. EVO/EVO+ Visian Implantable Collamer Lenses for the correction of myopia and myopia with astigmatism. Expert Rev Med Devices 2023; 20:75-83. [PMID: 36708714 DOI: 10.1080/17434440.2023.2174429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Intraocular lens implantation in phakic eyes for the correction of refractive error is currently a widespread procedure. The EVO and EVO+ Visian Implantable Collamer Lenses (ICL) are two of the most prevalent lenses implanted. They incorporate a central orifice to avoid the need for iridotomy. The main difference between both ICL is the higher optical diameter zone provided by the EVO+, allowing a better quality of vision at night. This review aims to provide an overview of the current ICL models available for correcting myopia and myopic astigmatism. AREAS COVERED During the last decade, more than 100 scientific papers analyzing the performance of EVO and EVO+ lenses have been published. This review describes the objective visual performance achieved with the implantation of central hole ICL lenses and the subjective perception of the patients implanted with these lenses. In addition, the safety and the potential complications associated with undergoing an EVO and EVO+ ICL implantation have been addressed. EXPERT OPINION Refractive surgeons and candidates to undergo ICL implantation should be aware of the excellent safety and visual outcomes provided by the implantation of central hole ICL lenses. However, future research could address minor issues currently not resolved.
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Affiliation(s)
- Elena Martínez-Plaza
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
| | | | - Alberto López-Miguel
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
| | - Alfredo Holgueras
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
| | - Miguel J Maldonado
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
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14
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Qian T, Du J, Ren R, Zhou H, Li H, Zhang Z, Xu X. Vault-Correlated Efficacy and Safety of Implantable Collamer Lens V4c Implantation for Myopia in Patients with Shallow Anterior Chamber Depth. Ophthalmic Res 2023; 66:445-456. [PMID: 36596292 DOI: 10.1159/000528616] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/27/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The aim of the study was to evaluate efficacy and safety outcomes after implantation of the Visian Implantable Collamer Lens (ICL V4c) in myopia patients with shallow anterior chamber depth (ACD). METHODS This retrospective study followed 163 eyes of 94 patients for at least 24 months. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, intraocular pressure (IOP), manifest refraction, vault, endothelial cell density (ECD), anterior chamber angle (ACA), anterior chamber volume, and the distance from the corneal endothelium to the central ICL (C-ICL) were measured during follow-ups. Spearman's correlation and logistic regression were used to identify variables correlated with changes in ECD and potential risk factors for ineffective outcomes, respectively. RESULTS All surgeries were performed safely. High IOP of 9 eyes and anterior capsular opacity of 5 eyes were observed. The last follow-up ACA had a significant difference between the high and normal IOP groups (p = 0.0003). The mean ECD and vault were 2,855.76 ± 270.82 cells/mm2 and 388.01 ± 135.28 μm at the last follow-up, respectively. The vault and C-ICL were significantly associated with ΔECD (all p < 0.05). Furthermore, the vault was most responsible for the ECD loss. Twenty-two eyes had unsatisfactory postoperative UDVA, and the low vault at the last follow-up was a significant risk factor for this ineffective outcome (p < 0.001, OR = 14.739). CONCLUSIONS ICL V4c implantation in patients with shallow ACD achieved stable visual outcomes. The vault is related to postoperative visual acuity and ECD loss, which needs to be paid attention during follow-up.
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Affiliation(s)
- Tianwei Qian
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
| | - Jingxiao Du
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
| | - Ruixia Ren
- Shanghai Xinshijie Zhongxing Eye Hospital, Shanghai, China
| | - Hao Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
| | - Haiyan Li
- Shanghai Xinshijie Zhongxing Eye Hospital, Shanghai, China
| | - Zhihua Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, China
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Nassar GA, Abbas EN, Khalil MMAA, Tharwat E, Mohammed AR. Evaluation of Higher Order Aberrations and Anterior Segment Parameters Changes After Implantable Collamer Lens Implantation for High Myopia. Clin Ophthalmol 2023; 17:1097-1107. [PMID: 37064961 PMCID: PMC10103779 DOI: 10.2147/opth.s405182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/17/2023] [Indexed: 04/18/2023] Open
Abstract
Purpose To evaluate changes in higher order aberrations (HOAs) induced by implantable collamer lens (ICL) implantation in correction of high myopia and to compare the anterior segment parameters before and after surgery. Also, to correlate these parameters with HOAs, the best corrected visual acuity (BCVA) and intraocular pressure (IOP). Methods This prospective interventional cohort case series study included 40 eyes with high myopia that underwent ICL V4c implantation. They were evaluated pre-operatively and post-operatively at 1st and 3rd month HOAs using Scheimpflug Sirius Camera. The anterior segment parameters were evaluated by optical biometry. Correlations between HOAs, BCVA and anterior segment parameters were evaluated. Results The mean pre-operative BCVA was 0.67 ± 0.17, while post-operative BCVA was 0.74 ± 0.16 (p-value < 0.001). The spherical equivalent was -13.66 ± 2.23 pre-operatively, while post-operatively it was -0.77 ± 0.65 (p-value < 0.001). The mean pre-operative root mean square (RMS) of HOAs was 0.62 ± 0.11 µm, while mean post-operative RMS in the 1st month was 0.82 ± 0.29 µm (p-value < 0.001). At 3rd month, it was 0.63 ± 0.17 µm (p-value = 0.685). The mean pre-operative anterior chamber depth (ACD) was 3.66 ± 0.26 mm. It decreased in the post-operative 1st month to 3.46 ± 0.30 mm, while in 3rd month 3.45 ± 0.24 mm (p-value < 0.001, < 0.001) respectively. The mean pre-operative anterior chamber angle (ACA) 45.98 ± 8.39 o while, the mean ACA was 31.65 ± 4.14, 31.03 ± 3.74 post-operatively (p-value < 0.001, < 0.001) respectively. There was significant increase in IOP (p-value < 0.001). Conclusion ICL implantation is safe and effective in correction of high myopia, as HOAs increase at first month post-operatively then, return to the pre-operative level by 3rd month. However, anterior segment parameters show significant changes which may need longer follow up.
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Affiliation(s)
- Ghada A Nassar
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
- Correspondence: Ghada A Nassar, 10 Said Street, Heliopolis, Cairo, 11757, Egypt, Tel +2 01222397300, Fax +20223636504, Email
| | - Ezzat N Abbas
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Ehab Tharwat
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed R Mohammed
- Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Wu H, Zhong DJ, Luo DQ, Zhang LY, Liu J, Wang H. Improvement in the ideal range of vault after implantable collamer lens implantation: a new vault prediction formula. Front Med (Lausanne) 2023; 10:1132102. [PMID: 37181381 PMCID: PMC10174235 DOI: 10.3389/fmed.2023.1132102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background To derive and validate a novel vault prediction formula to improve the predictability and safety of implantable collamer lens (ICL) implantation. Methods Thirty-five patients (61 eyes) with previous posterior chamber intraocular lens implantation were included. Various parameters, such as horizontal-visible iris diameter (HVID), photopic pupil diameter (PPD), axial length (AL), white-to-white (WTW), anterior chamber width (ACW), angle-to-angle (ATA), crystalline lens rise (CLR), anterior chamber depth (ACD), horizontal sulcus-to-sulcus (HSTS), and ciliary sulcus angle (CSA) were measured. Vault was measured at 3 months after surgery using CASIA2 anterior segment optical coherence tomography. The formula was derived using multiple linear regression analysis and named as WH formula. It was validated in 65 patients (118 eyes) to determine the percentage of the ideal postoperative vault range and to compare the differences between the WH formula and the NK, KS, and STAAR formulas. Results Final ICL size, ATA, CSA, and CLR were included in the prediction formula model (adjusted R2 = 0.67, p < 0.001). The achieved vault 1 month after the surgery was 556.19 μm ± 166.98 μm in the validation group, and the ideal vault range was 200-800 μm (92%). The difference between the achieved vault and that predicted using the WH formula was not statistically significant (p = 0.165), whereas the difference between the achieved vault and that predicted using the NK and KS formulas was statistically significant (p < 0.001 and p < 0.001, respectively). The 95% agreement limit range of the achieved vault and the vault predicted using the WH formula was narrower than those predicted using the NK and KS formulas (-295.20-258.82 μm). Conclusion This study combined the results of optical coherence tomography and ultrasound biomicroscopy measurements of the anterior segment of the eye and incorporated ciliary sulcus morphology quantification into the prediction formula. The study derived a prediction formula for vault by combining ICL size, ATA, and CLR. The derived formula was found to be superior to the currently available formulas.
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17
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Sánchez Trancón A, Cerpa Manito S, Torrado Sierra O, Baptista AM, Serra PM. Vault differences in eyes implanted with spherical and toric implantable collamer lenses: an inter-eye analysis. BMC Ophthalmol 2022; 22:435. [PMCID: PMC9664806 DOI: 10.1186/s12886-022-02653-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose
To determine the influence of implantable collamer lenses (ICL) geometry, i.e. spherical and toric on the vault, and report the refractive and visual outcomes of patients bilaterally implanted with the two ICL geometries.
Methods
This retrospective case series analysed 41 patients implanted with a spherical ICL (sICL) in one eye and an equal sized toric ICL (tICL) in the fellow eye. The anatomical and ICL-related parameters were assessed using anterior-segment optical coherence tomography (AS-OCT Visante, Zeiss Meditec AG) and optical tomography (Pentacam, OCULUS). The influence of the anatomical and ICL-related parameters on the vault was determined using generalised estimating equations (GEE) to incorporate inter-eye correlations.
Results
Postoperative spherical equivalent was within ± 0.50D in 66% and 83% of the eyes, respectively implanted with sICL and tICL. The efficacy index in the sICL group was 1.06 and 1.14 in the tICL group. The mean inter-eye vault difference was -1.46 µm, anatomical and ICL-related parameters showed similar associations with the vault for sICL and tICL. The GEE identified the ICL size minus the anterior chamber width, the ICL spherical power and ICL central thickness as significant factors influencing the vault.
Conclusions
Spherical and toric ICL showed good efficacy for the correction of myopia and astigmatism. Patients implanted bilaterally with sICL and tICL tend to present similar vaults. The vault produced by both types of ICL was mainly regulated by the oversizing of the ICL. This suggests that the ICL geometry (spherical vs toric) is a factor with limited influence on the vault, thus the sizing method of a sICL and tICL should be similar.
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18
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Khan MA, Tan Q, Sun W, Cai W, Zhao L, Lin D. Prediction of excessively low vault after implantable collamer lens implantation using iris morphology. Front Med (Lausanne) 2022; 9:1029350. [PMID: 36388920 PMCID: PMC9650031 DOI: 10.3389/fmed.2022.1029350] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To identify the iris morphology-related factors for prediction of outcomes of excessively low vault (< 100 μm) after Implantable Collamer Lens V4c (ICL V4c; STAAR Surgical) implantation. Methods This retrospective case-control study included 81 eyes from 2,080 patients who underwent ICL implantation. Twenty-seven eyes of 27 patients with excessively low vault (< 100 μm) constituted the case group (excessively low vault group). Patients with vault (250 to 750 μm) were selected as the optimal vault group by matching anterior chamber depth, white-to-white distance and ICL size with cases with excessive low vault (< 100 μm) at a proportion of 1:2. The preoperative biometric parameters and postoperative vault were recorded. Multiple linear regression analysis was performed to assess the relationship between the postoperative vault and various variables. Conditional logistic regression analysis was used to estimate the risk factors for excessively low vault. Results The postoperative vault was associated with preoperative pupil diameter (PD), crystalline lens rise, iris concavity and the ratio of the iris concavity to chord length (P < 0.05). The larger iris concavity increased risk of excessively low postoperative vault (< 100 μm) (OR = 81.10; 95%CI = 2.87 to 2296.58; P = 0.01). Conclusions Eyes with obviously concave iris were associated with a higher rate of excessively low vault (< 100 μm). Evaluation of iris morphology may provide significant information for predicting excessive postoperative vault.
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Affiliation(s)
- Muhammad Ahmad Khan
- Aier School of Ophthalmology, Central South University, Changsha, China
- Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, China
| | - Qian Tan
- Aier School of Ophthalmology, Central South University, Changsha, China
- Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, China
| | - Wei Sun
- Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, China
| | - Wang Cai
- Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, China
| | - Libei Zhao
- Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, China
- *Correspondence: Ding Lin
| | - Ding Lin
- Aier School of Ophthalmology, Central South University, Changsha, China
- Department of Ophthalmology, Changsha Aier Eye Hospital, Changsha, China
- Libei Zhao
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Guan N, Zhang XN, Zhang WJ. Correlation between intraoperative and postoperative vaulting of the EVO implantable Collamer lens: a retrospective study of real-time observations of vaulting using the RESCAN 700 system. BMC Ophthalmol 2022; 22:2. [PMID: 34980022 PMCID: PMC8721482 DOI: 10.1186/s12886-021-02237-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/22/2021] [Indexed: 12/19/2022] Open
Abstract
Background Implantable Collamer lens (ICL) vaulting is one of the most important parameters for the safety, aqueous humor circulation, and lens transparency after ICL implantation. This study aimed to investigate the factors associated with the actual vaulting after refractive EVO-ICL surgery. Methods This retrospective study included patients who underwent EVO-ICL surgery at a tertiary eye hospital between October and December 2019. A RESCAN 700 was used for the intraoperative and CIRRUS HD-OCT was used for postoperative observation of vaulting. Subjective and objective refractions, anterior ocular segment, corneal morphology, intraocular pressure (IOP), anterior chamber volume (ACV), crystalline lens rise (CLR), white-to-white distance (WTW), anterior chamber depth (ACD), axial length, corneal endothelial cell density (ECD), and fundoscopy were examined. A multivariable analysis was performed to determine the factors independently associated with 1-month postoperative vaulting. Results Fifty-one patients (102 eyes) were included. Compared with the eyes with normal vaulting, those with high vaulting had higher preoperative diopter values (P = 0.039), lower preoperative corrected visual acuity (P = 0.006), lower preoperative IOP (P = 0.029), higher preoperative ACD (P = 0.004), lower preoperative CLR (P = 0.046), higher ICL spherical equivalent (P = 0.030), higher intraoperative vaulting (P < 0.001), and lower IOP at 1 month (P = 0.045). The multivariable analysis showed that the only factor independently associated with high vaulting at 1 month after surgery was the intraoperative vaulting value (odds ratio = 1.005, 95% confidence interval: 1.002–1.007, P < 0.001). The intraoperative and 1-month postoperative vaulting values were positively correlated (R2 = 0.562). Conclusions The RESCAN700 system can be used to perform intraoperative optical coherence tomography to predict the vaulting value of ICL at 1 month.
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Affiliation(s)
- Nian Guan
- Department of Refractive, Wuhan Bright Eye Hospital, Wuhan, 430000, Hubei, China
| | - Xiao-Nong Zhang
- Department of Refractive, Hefei Bright Eye Hospital, Hefei, 230000, Anhui, China
| | - Wan-Jun Zhang
- Department of Refractive, Hefei Bright Eye Hospital, Hefei, 230000, Anhui, China.
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Zhao J, Zhao J, Yang W, Li M, Hao G, Chen Z, Wang X, Yao P, Zhou X. Consecutive contralateral comparison of toric and non-toric implantable collamer lenses V4c in vault after implantation for myopia and astigmatism. Acta Ophthalmol 2021; 99:e852-e859. [PMID: 33369209 DOI: 10.1111/aos.14720] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
AIMS To compare the vault performance between implantable collamer lens (ICL) V4c and Toric ICL (TICL) V4c after implantation and to investigate the affecting factors. METHODS Sixty-eight eyes from 34 patients with myopia or myopia astigmatism who underwent implantation of TICL in one eye (group A) and identically sized ICL (group B) in the contralateral eye were included. Mean follow-up time were 7.58 ± 1.63 months (range: 6-10 months). Vault was compared between the two groups and correlations between vault and age, preoperative ocular biometric measurements were analysed. Generalized estimating equation (GEE) model of postoperative vault adjusting for within-patient intereye correlations was performed. RESULTS The safety indices were 1.27 and 1.35, and the efficacy indices were 1.20 and 1.24 for groups A and B, respectively. Vault of TICL was significantly higher than that of ICL (554.11 ± 219.36 μm vs 449.70 ± 172.47 μm, P < 0.001). The difference between ICL/TICL size and WTW (size-WTW) and STS (size-STS), anterior chamber depth and pupil diameter (PD) were positively correlated with vault. Patient age and clear lens rise measured by Pentacam were negatively correlated with vault. Results of GEE model showed preoperative PD, age, cylindrical power of TICL and size-WTW were influencing factors for postoperative vault. CONCLUSIONS Vault after TICL implantation is higher than that with ICL. PD, age, cylindrical power of TICL and size-WTW could affect postoperative vault.
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Affiliation(s)
- Jiao Zhao
- Department of Ophthalmology People’s Hospital of Leshan Leshan China
| | - Jing Zhao
- Eye Institute and Department of Ophthalmology Eye & ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Key Laboratory of Myopia Chinese Academy of Medical Sciences Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Wen Yang
- Department of Ophthalmology The Third People’s Hospital of Chengdu The Affiliated Hospital of Southwest Jiaotong University Chengdu China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology Eye & ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Key Laboratory of Myopia Chinese Academy of Medical Sciences Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Gengsheng Hao
- Department of Ophthalmology People’s Hospital of Leshan Leshan China
| | - Zhuoyi Chen
- Eye Institute and Department of Ophthalmology Eye & ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Key Laboratory of Myopia Chinese Academy of Medical Sciences Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology Eye & ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Key Laboratory of Myopia Chinese Academy of Medical Sciences Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Peijun Yao
- Eye Institute and Department of Ophthalmology Eye & ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Key Laboratory of Myopia Chinese Academy of Medical Sciences Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology Eye & ENT Hospital Fudan University Shanghai China
- NHC Key Laboratory of Myopia (Fudan University) Key Laboratory of Myopia Chinese Academy of Medical Sciences Shanghai China
- Shanghai Research Center of Ophthalmology and Optometry Shanghai China
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Use of neural networks to predict vault values after implantable collamer lens surgery. Graefes Arch Clin Exp Ophthalmol 2021; 259:3795-3803. [PMID: 34313826 PMCID: PMC8589809 DOI: 10.1007/s00417-021-05294-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/03/2021] [Accepted: 06/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Appropriate sizing of the implantable collamer lens (ICL) and accurate prediction of the vault are crucial prior to surgery. However, sometimes, the vault value is higher or lower than predicted, necessitating reoperation. The present study aimed to develop neural networks for improving predictions of vault values following ICL implantation based on preoperative biometric data. Methods This retrospective study included 137 eyes of 74 patients with ICLs. Linear regression and neural network analyses were used to examine the relationship between vault values at the 6-month follow-up and preoperative parameters (e.g., ICL characteristics and biometrics). Results Linear regression analysis revealed that vault values were correlated with five variables: ICL size, anterior chamber depth (ACD), angle-to-angle (ATA), white-to-white (WTW), and lens thickness (LT) (adjusted R2 = 0.411). Inclusion of more input variables was associated with better performance in the neural network analysis. The degree of fit when all 11 variables were included in the neural network model was close to 1 (R2 = 0.98). R2 values for the quaternary neural network model enrolling four input variables (ICL size, ATA, ACD, and LT) reached 0.90. Conclusions A neural network equation including the ICL size and biometric parameters of the anterior segment (ATA, ACD, and LT) can be used to predict the postoperative vault, aiding in the selection of an appropriate ICL size and reducing the need for reoperation after surgery.![]() Supplementary Information The online version contains supplementary material available at 10.1007/s00417-021-05294-x.
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22
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Determining vault size in implantable collamer lenses: preoperative anatomy and lens parameters. J Cataract Refract Surg 2021; 46:728-736. [PMID: 32358268 DOI: 10.1097/j.jcrs.0000000000000146] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine patient preoperative anatomical features and the parameters of implantable collamer lenses (ICLs) relevant in explaining vault variability. SETTING Ophthalmology Clinic Vista Sánchez Trancón, Badajoz, Spain. DESIGN Retrospective case series. METHODS This study comprised 360 eyes of 360 patients implanted with myopic or toric ICLs. Pentacam imaging was used for assessing white-to-white (WTW) diameter, central keratometry, and central corneal thickness. Anterior-segment optical coherence tomography was used to measure the horizontal anterior chamber angle distance (ATA), internal anterior chamber (ACQ), crystalline lens rise (CLR), anterior chamber angle (ACA), and vault. The sample was divided according to the implanted lens size (12.6 mm, 13.2 mm, and 13.7 mm). Vault predictors were identified from the variables above using multivariate regression analysis. RESULTS The groups showed significant statistical differences for WTW, ATA, ACQ, ACA, and vault (P < .007 for all). In general, bigger lenses were implanted in eyes with larger transverse sizes (WTW and ATA) and deeper ACQ. Also, larger ICL diameters were associated with higher vaults. Multivariate regression analysis identified the lens size (13.2 mm as reference; 12.6 mm: β [standardized coefficients] = -0.33; 13.7 mm: β = 0.42), ATA (β = -0.42), and CLR (β = -0.25), ICL spherical equivalent (β = -0.22) and patient age (β = -0.12) as predictors of the vault size (adjusted-R = 0.34 P < .001). CONCLUSIONS The multivariate model explained 34% of vault variability. The predictors indicated the presence of different mechanisms regulating the vault. These involved the difference between the transverse size of the eye and the ICL, the crystalline lens protrusion, and the ICL properties, such as power and size.
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Optimization of implantable collamer lens sizing based on swept-source anterior segment optical coherence tomography. J Cataract Refract Surg 2021; 46:742-748. [PMID: 32358270 DOI: 10.1097/j.jcrs.0000000000000134] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To optimize the implantable collamer lens (ICL) sizing method using anterior segment optical coherence tomography (AS-OCT). SETTING Nagoya Eye Clinic, Nagoya, Japan. DESIGN Interventional case series. METHODS A stepwise multiple regression analysis was performed using the optimal ICL size as a dependent variable and preoperative AS-OCT parameters as explanatory variables for 81 eyes of 41 patients, and the NK-formula version 2 (NK-formula V2) was obtained. Thereafter, 68 eyes of 42 patients were implanted with the ICLs selected as closest to the optimal ICL size calculated by the NK-formula V2. At 3 months postoperatively, the achieved vault was measured by AS-OCT to evaluate the optimization of the sizing method. RESULTS The anterior chamber width (ACW) and crystalline lens rise were selected as significant parameters for the regression model (R = 0.61, P < .001), as with the previous NK-formula. Of the 68 eyes, 36 patients/62 eyes (91.2%), 5 patients/5 eyes (7.3%), and 1 patient/1 eye (1.5%) were in the moderate, high, and low vault categories, respectively. In the 68 eyes, the vault showed no correlation with the optimal ICL size (R = 0.0185, P = .269), whereas the vault showed a negative correlation with the optimal ICL size in both the 12.6 mm ICL subgroup (R = -0.409, P = .0088) and the 13.2 mm ICL subgroup (R = -0.818, P = .0013). CONCLUSIONS This optimization approach showed excellent ability to select an appropriate ICL to be implanted regardless of the value of other ocular parameters and age, except ACW.
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Cerpa Manito S, Sánchez Trancón A, Torrado Sierra O, Baptista AM, Serra PM. Biometric and ICL-related risk factors associated to sub-optimal vaults in eyes implanted with implantable collamer lenses. EYE AND VISION 2021; 8:26. [PMID: 34225809 PMCID: PMC8256545 DOI: 10.1186/s40662-021-00250-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/30/2021] [Indexed: 12/05/2022]
Abstract
Background To identify biometric and implantable collamer lens (ICL)-related risk factors associated with sub-optimal postoperative vault in eyes implanted with phakic ICL. Methods This study reports a retrospective case series of the first operated eye in 360 patients implanted with myopic spherical or toric ICL. Preoperatively, white-to-white (WTW), central keratometry (Kc) and central corneal thickness (CCT) were measured using the Pentacam. Anterior-segment optical coherence tomography (AS-OCT, Visante) was applied preoperatively for measuring the horizontal anterior-chamber angle-to-angle distance (ATA), internal anterior chamber depth (ACD), crystalline lens rise (CLR), anterior-chamber angle (ACA) and postoperatively the vault. Eyes were divided into three vault groups: low (LVG: ≤ 250 μm), optimal (OVG: > 250 and < 1000 μm) and high (HVG: ≥ 1000 μm). Multinomial logistic regression (MLR) was used to find the sub-optimal vault predictors. Results MLR showed that CLR, ICL size minus the ATA (ICL size-ATA), age, ICL spherical equivalent (ICLSE) and ICL size as contributing factors for sub-optimal vaults (pseudo-R2 = 0.40). Increased CLR (OR: 1.01, CI: 1.00–1.01) and less myopic ICLSE (OR: 1.22, CI: 1.07–1.40) were risk factors for low vaults. Larger ICL size-ATA (OR: 41.29, CI: 10.57–161.22) and the 13.7 mm ICL (OR: 7.08, CI: 3.16–15.89) were risk factors for high vaults, whereas less myopic ICLSE (OR: 0.85, CI: 0.76–0.95) and older age (OR: 0.92, CI: 0.88–0.98) were protective factors. Conclusion High CLR and low ICLSE were the major risk factors in eyes presenting low vaults. In the opposite direction, ICL size-ATA was the major contributor for high vaults. This relationship was more critical in higher myopic ICLSE, younger eyes and when 13.7 mm ICL were used. The findings show that factors influencing the vault have differentiated weight of influence depending on the type of vault (low, optimal or high). Supplementary Information The online version contains supplementary material available at 10.1186/s40662-021-00250-6.
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Affiliation(s)
- Santiago Cerpa Manito
- Research and Development Department, Ophthalmology Clinic Vista Sánchez Trancón, Building Tecnolaser, Room 14 Calle La Violeta, 06005, Badajoz, Spain
| | - Angel Sánchez Trancón
- Research and Development Department, Ophthalmology Clinic Vista Sánchez Trancón, Building Tecnolaser, Room 14 Calle La Violeta, 06005, Badajoz, Spain
| | - Oscar Torrado Sierra
- Research and Development Department, Ophthalmology Clinic Vista Sánchez Trancón, Building Tecnolaser, Room 14 Calle La Violeta, 06005, Badajoz, Spain
| | | | - Pedro Miguel Serra
- Research and Development Department, Ophthalmology Clinic Vista Sánchez Trancón, Building Tecnolaser, Room 14 Calle La Violeta, 06005, Badajoz, Spain. .,Optics and Optometry Department, Instituto Superior de Educação e Ciências, Lisbon, Portugal.
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Barros L, Sena N, Motta C, Criado G, Ambrósio R. Lentes intraoculares fácicas para miopia e astigmatismo: revisão prospectiva. REVISTA BRASILEIRA DE OFTALMOLOGIA 2021. [DOI: 10.37039/1982.8551.20210012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Zhu QJ, Chen WJ, Zhu WJ, Xiao HX, Zhu MH, Ma L, Yuan Y, Song E. Short-term changes in and preoperative factors affecting vaulting after posterior chamber phakic Implantable Collamer Lens implantation. BMC Ophthalmol 2021; 21:199. [PMID: 33957891 PMCID: PMC8101126 DOI: 10.1186/s12886-021-01963-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background To describe the very early vault changes in the first month after Implantable Collamer Lens (ICL) implantation and to evaluate the effect of preoperative biometric factors on vault. Methods Eighty-three eyes from eighty-three subjects with complete data who met follow-up requirements were recruited in this retrospective study between May 2019 and March 2020. We quantitatively assessed the postoperative vault at 2 h, 1 day, 1 week, and 1 month following implantation. Associations between the postoperative vault and age, ICL size, spherical equivalent (SE), axial length (AL), central corneal thickness (CCT), flat keratometry (K), steep K, mean K, anterior chamber depth (ACD), crystalline lens thickness (LT), white-to-white (WTW) diameter obtained by three devices, horizontal and vertical sulcus-to-sulcus (STS) diameter, bright and dark pupil sizes (BPS and DPS) and DPS-BPS were investigated using Spearman’s correlation analysis and stepwise multiple regression analysis. Results The mean vault values at 2 h, 1 day, 1 week, and 1 month after ICL implantation were 672.05 ± 30.72, 389.15 ± 28.33, 517.23 ± 30.76 and 530.12 ± 30.22 μm, respectively. Significant differences were found in the vault values at 2 h, 1 day and 1 week after the operation. The ICL size (β = 0.942; p < 0.001), followed by horizontal STS (β = -0.517; p < 0.001), crystalline LT (β = -0.376; p < 0.001) and vertical STS (β = -0.257; p = 0.017), significantly influenced the vault at 1 month after the operation. The multiple regression equation was expressed as follows: central vault (µm) = -1369.05 + 657.121 × ICL size- 287.408 × horizontal STS − 432.497 × crystalline LT − 137.33 × vertical STS (adjusted R2 = 0.643). Conclusions After ICL implantation, the vault decreased and then increased, but it did not return to the vault value 2 h after surgery. The ICL size, horizontal and vertical STS and crystalline LT are key factors for predicting postoperative vaulting. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01963-x.
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Affiliation(s)
- Qiu-Jian Zhu
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Jiangsu, 215021, Suzhou, China
| | - Wen-Jing Chen
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Jiangsu, 215021, Suzhou, China
| | - Wei-Jian Zhu
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Jiangsu, 215021, Suzhou, China
| | - Hai-Xiang Xiao
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Jiangsu, 215021, Suzhou, China
| | - Man-Hui Zhu
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Jiangsu, 215021, Suzhou, China
| | - Lie Ma
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Jiangsu, 215021, Suzhou, China
| | - You Yuan
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Jiangsu, 215021, Suzhou, China.
| | - E Song
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Jiangsu, 215021, Suzhou, China
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27
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Montés‐Micó R, Ruiz‐Mesa R, Rodríguez‐Prats JL, Tañá‐Rivero P. Posterior-chamber phakic implantable collamer lenses with a central port: a review. Acta Ophthalmol 2021; 99:e288-e301. [PMID: 32841517 PMCID: PMC8246543 DOI: 10.1111/aos.14599] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023]
Abstract
We aimed to summarize the outcomes reported following the implantation of the V4c implantable collamer lens with a central port (ICL, STAAR Surgical Inc) for myopia correction. A literature search in PubMed, Web of Science and Scopus was carried out to identify publications reporting clinical outcomes of patients who were implanted with the V4c ICL model and had a follow‐up period of at least 6 months. A total of 35 clinical studies published between 2012 and 2020 were included in the present review. A comprehensive analysis of the available data was performed, focusing on visual and refractive outcomes at different time‐points post‐surgery. In addition, adverse events and other parameters such as endothelial cell density, intraocular pressure and vault measurements—which were evaluated in some of the studies—were also compared. This review encompassed a total of 2904 eyes. The outcomes reported in this review lead us to conclude that ICL V4c implantation for myopia correction is a safe and efficient procedure, with stable visual and refractive outcomes and low adverse event rates. The patient’s anterior segment should be thoroughly characterized, and the ICL parameters should be carefully selected so as to achieve good outcomes and avoid complications.
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Affiliation(s)
- Robert Montés‐Micó
- Oftalvist Alicante Spain
- Optics and Optometry and Vision Sciences Department University of Valencia Valencia Spain
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28
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Jonker SMR, Berendschot TTJM, Saelens IEY, Bauer NJC, Nuijts RMMA. Phakic intraocular lenses: An overview. Indian J Ophthalmol 2020; 68:2779-2796. [PMID: 33229653 PMCID: PMC7856940 DOI: 10.4103/ijo.ijo_2995_20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Phakic intraocular lenses (pIOLs) are a common solution for the surgical correction of high myopia and myopia in thin corneas. Global trends result in increasing rates of patients with high myopia which will result in increased rates of pIOL implantation. Three types of lenses can be distinguished: anterior chamber angle-supported, anterior chamber iris-fixated, and posterior chamber phakic IOLs. The efficacy of phakic intraocular lenses is generally very good, but pIOLs have undergone many changes over the years to improve the safety profile and decrease pIOL-related complications such as endothelial cell loss, corneal decompensation and cataract formation. This article describes the efficacy and safety profiles of the most recent pIOLs, as well as suggests gaps of knowledge that are deserve additional research to optimize the results of pIOLs.
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Affiliation(s)
- Soraya M R Jonker
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Noël J C Bauer
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, The Netherlands
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Cerpa Manito S, Sánchez Trancón A, Torrado Sierra O, Baptista AMG, Serra PM. <p>Inter-Eye Vault Differences of Implantable Collamer Lens Measured Using Anterior Segment Optical Coherence Tomography</p>. Clin Ophthalmol 2020; 14:3563-3573. [PMID: 33154615 PMCID: PMC7605967 DOI: 10.2147/opth.s258817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/12/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
| | | | | | | | - Pedro Miguel Serra
- Ophthalmology Clinic Vista Sánchez Trancón, Badajoz, Spain
- Optics and Optometry Department, Instituto Superior de Educação e Ciências, Lisbon, Portugal
- Correspondence: Pedro Miguel Serra Email
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30
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Gonzalez-Lopez F, Bilbao-Calabuig R, Mompean B, Luezas J, Ortega-Usobiaga J, Druchkiv V. Determining the Potential Role of Crystalline Lens Rise in Vaulting in Posterior Chamber Phakic Collamer Lens Surgery for Correction of Myopia. J Refract Surg 2019; 35:177-183. [PMID: 30855095 DOI: 10.3928/1081597x-20190204-01] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/30/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the effect of crystalline lens rise (CLR) on postoperative vault in eyes implanted with a phakic Visian Implantable Collamer Lens (ICL) (STAAR Surgical Company, Monrovia, CA) with a central port for myopic correction. METHODS Non-invasive Fourier-domain swept-source anterior segment optical coherence tomography was used for dynamic assessment of the study eyes under changing light conditions. Phakic intraocular lens (IOL) vault, anterior chamber depth (ACD), and CLR were recorded after surgery, and intra-eye differences were analyzed under scotopic and photopic ambient light conditions. Inter-group analysis and regression analysis were performed to investigate any potential correlation between these biometric variables. RESULTS This retrospective observational study comprised 111 eyes (65 patients) implanted with a myopic Visian ICL. The mean change in CLR from mydriasis to miosis was 59 ± 60 µm (P < .001). The sample was further divided into four groups according to the CLR value in miosis: CLR < 0, 0 to 200, 201 to 350, and > 350 µm. A significant difference in central vault values was observed between the < 0 and > 350 µm groups, the 0 to 200 and 201 to 350 µm groups, and the 0 to 200 and > 350 µm groups (P < .05). Eyes with a high vault value (> 750 µm in mydriasis) had lower CLR values (P < .001) and higher ACD values (P < .001) than eyes with a low vault value (< 100 µm in miosis). The linear correlation observed was negative between CLR and ACD, positive between postoperative vault and ACD, and negative between postoperative vault and CLR (P < .001). CONCLUSIONS CLR significantly affected anterior chamber depth and postoperative ICL vault. [J Refract Surg. 2019;35(3):177-183.].
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